Topics:

• Utilization management processes and tools
• Case management
• Continuum of care
• Referral management
• Pharmacy management
• Committees and peer review
• Clinical care strategies
• Evidence-based medicine
• Clinical guidelines
• Disease management
• Health risk assessments

Content and topic goals: There is an infrastructure of sorts to help physicians and practices deliver cost-effective, efficient and coordinated care to their patients. By having programs and systems in place, clinicians can do a better job serving individuals and also managing the larger practice within a budget. This topic area covers several aspects of medical and care management. It describes the extended continuum of care and how physicians, with the help of case managers, can coordinate and monitor care for patients who require services beyond the practice setting. It presents strategies and tools for managing two critical components of care: referrals, so that generalists and specialists can collaborate to best effect, and prescription drugs, so that conditions are treated appropriately and cost-effectively. Along with these approaches, the content addresses physician-directed support systems-such as peer review mechanisms and committees-to help each physician and the practice as a whole manage care successfully.

Physicians and their clinical colleagues retain their fundamental responsibility of preventing, diagnosing and treating illness. To be most effective in the managed care environment, they need to apply the best-known practices to individual cases and patient groups. This topic area describes how physicians can practice evidence-based medicine, a process of finding answers to clinical questions to produce the best outcomes. A related strategy for reducing unwarranted variation across patients and providers in order to achieve the best care for all is the development and implementation of clinical guidelines for specific diagnostic and treatment situations. More inclusive approaches to treating patients with certain conditions are catalogued as disease management programs. Learners are trained to understand and apply these tools, along with the techniques for assessing risk factors in all patients in order to provide care and promote self-care as appropriate to the patient's level of need.

Topics:

• Decision-support systems
• Practice patterns and performance profiles
• Patient population profiles
• Patient-oriented information applications

Content and topic goals: The impact of emerging information technologies is pervasive throughout society. In health care, which has been relatively slow to apply these tools, providers and consumers alike are increasingly affected. Physicians and their colleagues need sophisticated information systems to guide clinical decision-making, to keep track of and help manage their practices, and to assess their utilization patterns and outcomes. Consumers also have increased access to information on health and illness. In response, clinicians need to act as information consultants to their patients and to adjust to serving a more informed clientele.